胸背动脉穿支皮瓣的解剖学研究及其在头颈修复中的意义

Anatomy study of thoracodorsal artery perforator flap and its clinical significance in reconstruction of head and neck defects

目的探讨胸背动脉穿支皮瓣的解剖学基础及其在头颈修复中的临床意义。方法解剖新鲜成人尸体5具,观察、测量胸背动脉穿支皮瓣供血穿支的数目、类型、管径、蒂长、走行、出筋膜后轴向及源血管外径,并对其定位。结果胸背动脉穿支44支,其中肌皮穿支35支、肌间隔/直接皮穿支9支。胸背动脉内侧支的肌皮穿支数占38.6%。胸背动脉外侧支的皮穿支数占54.5%,大部分位于背阔肌前缘2 cm之内。最粗穿支血管平均蒂长(12.41±2.84)cm。肩胛下动静脉外径(3.59±0.62)(、3.75±0.41)mm,胸背动静脉外径(2.71±0.43)(、2.98±0.18)mm。结论胸背动脉的穿支血管解剖位置较为恒定,穿支皮瓣制作方便,其管径及蒂长均适宜头颈肿瘤术后缺损的修复。

Objective To study the anatomy of the thoracodorsal artery perforator flap （TDAPF） and explore its clinical application in reconstruction of head and neck defects. Methods Five fresh cadavers were prepared, and morphosis and blood supply of TDAP flaps were examined by microsurgical anatomy. During dissections, the following parameters were recorded： number and type of perforators vessels, diameter of perforators, pedicle length, diameter of the original vessels, mute （infra fascia and supra fascia）, and their position were located by anatomical landmarks. Results There were 44 TDAP flap perforators in all specimen with 54.5% from the lateral branch and 36.8% from the medial branch of the thoracodorsal artery. The lateral branch perforator was mostly located within 2 cm of the anterior border of the latissimus dorsi muscle. Mean pedicle length of the largest perforator was 12.41 ± 2.84 cm. Average diameter of the infrascapular artery and the infrascapular vein was 3.59 ±0.62 mm and 3.75±0.41 ram, and that of the thoracodorsal artery and the thoracodorsal vein was 2.71±0.43 mm and 2.98 ±0. 18 mm. Conclusion TDAP flaps are useful in reconstruction of head and neck defects because of their constant position, large caliber, and long pedicle.